Stronger for Longer Director of Public Health Annual Report 2019

Contents

How we can all live stronger for longer

Find out what the term frailty means and how it differs from ageing.

Making healthy choices a habit

Discover how our habits can help keep us strong.

Our mental health matters

Top tips for managing our mental health and wellbeing.

Strength in our relationships

Uncover the many benefits of building and sustaining relationships.

Working together

Make the most of your medical appointments by following our easy guide.

A healthy environment for all

Explore how the environment impacts on our health.

References

Sources of information we have used to help inform this report.

2

3

5

7

9

11

13

This year’s annual report highlights the important issue of ageing well and reducing our chances of becoming frail in later life.

In a departure from previous approaches, the report takes the combined format of a short animation and the online publication you’re reading now. The aim is to try to reach as many people as possible around Derbyshire, and to get the message across in a way that everyone can relate to.

I’ve chosen the topic of frailty for an important reason; many of us assume that becoming frail is simply what happens as we get older. But frailty can be prevented. We can take steps now to build up what’s known as our ‘health reserves’ by adopting good habits throughout our lives. By making small changes now, this has the potential to make a huge difference later.

It means that we could live in better health, staying independent and well for longer. This is about how we age, adding life to our extra years so we can spend more time doing the things we enjoy independently. Not only is this good for us, it could have a positive effect on the health and social care sector, reducing some of the burden placed on already overstretched public services.

So, the message in this report is that, by investing in your health today, you could improve the quality of your life now and in the future. Together we can help to keep the Derbyshire population stronger for longer.

Dean Wallace, Director of Public Health

Derbyshire County Council

Welcome

Page

1

View the annual report animation at:

www.derbyshire.gov.uk/stronger

I am very grateful to all those involved in the production of this report.

How we can all live stronger for longer

1 in 10 17,169 people aged 65+ are estimated to have frailty in Derbyshire

1

2x

Women may be

twice as likely to

experience frailty

compared to men2,3

2038 24,430 people

with frailty in

Derbyshire

The number of

people with frailty is

increasing4

2

Managing Well

Frailty

Negative event e.g. illness

Quick recovery

Slow recovery

Increasing

health

reserves

Time and life events

Did you know that having good health is like saving coins in a jar?

The more we put in, the more we can get out. And the longer we save for - or build up our health reserves - the better the rewards later.

Why is this important?

As we get older, it’s obvious that we’re not going to be as fit and strong as we once were. We’re going to slow down a bit, and it might take us longer to get better when we’re ill, or if we’re recovering from an operation or injury.

But sometimes, something else can happen that makes getting older a lot tougher. This is more than simply getting older; it’s a state of health where our body systems gradually lose their in-built reserves.

This leaves us more vulnerable to sudden changes in health, triggered by what, in younger years, would have been small events, such as minor infections or changes in our environment or medication. This leaves us at increased risk of poorer health in the longer term and makes recovery more challenging. Medical professionals call this frailty.

It can be a big problem.

It’s estimated that around one in ten people aged 65 and over have frailty, and as many as one in five over 85 year olds - that’s over 17,000 people in Derbyshire

1. Some studies

have shown that, in general, woman may be at a slightly greater risk of frailty than men

2,3.

As our population ages, the number of people with frailty is set to rise by as much as 50% within the next 10-20 years

4.

Frailty - A clinical

definition

There is no universally agreed

definition of frailty yet, but a

useful practical one is:

“A medical syndrome with

multiple causes and

contributors that is

characterized by diminished

strength, endurance, and

reduced physiologic function

that increases an individual’s

vulnerability for developing

increased dependency and/or

death”5.

But none of this is inevitable.

Because it builds up over time, frailty can be delayed or even avoided altogether. By making small changes now…. we can make a big difference later. And we’ll be building up our reserves for when we need them.

Want to know more?

Over the next few pages we will look in more detail at some of the ways we can all live ‘stronger for longer’.

As well as providing you with practical tips, we will let you know what Derbyshire County Council and its partners are doing to help.

How our health reserves impact recovery

Making healthy choices a habit

Exercising can strengthen our mus-cles and bones as well as improving our balance—building our reserves for when we need them.

The odds of developing frailty are greater for those of us drinking alcohol above the recommended limits, compared to those drinking within

8.

22%

How does Derbyshire compare to England?

Stopping smoking is one of the best things we can do for our health, whatever our age. Research tells us that by stopping smoking we can also help prevent, or even reverse the symptoms of frailty too

7.

Combining exercise with a healthy diet, is much more effective at preventing or reversing frailty than exercise alone

9.

Getting the right amount of nutrients from our diet is key to staying strong.

Most of us would agree, if we really thought about what we could do to make sure our bodies and minds are as healthy as possible, we would:

Eat a balanced and healthy diet

Exercise our minds, as well as our bodies

Avoid smoking, drinking alcohol or taking harmful drugs

Find ways to be with others, as socialising is good for us

Are your daily habits keeping you well? Why does this matter?

A healthy lifestyle helps you to look and feel great; it also reduces your chances of becoming ill. Research suggests that by making healthy choices now, we can help delay or even prevent frailty later in life

6.

The good news is that it’s never too late to start. Even those of us already living with frailty can benefit. Acting now can help us to take back and maintain our independence as well as preventing illness and injury.

3

Be active Stop smoking Cut back the drink Eat Well

01

02

03

04

What can you do?

43% eat <5 portions of fruit & veg daily

Better than England 13

27% of adults have

too much alcohol

Similar to

England 12

14% of adults

smoke

Similar to

England 11

of adults are

physically inactive

Similar to

England 10

Healthy choices

and frailty -

what’s the link?

As we get older, our bodies start to slow down. But some changes can happen above and beyond what would be expected through ‘normal’ ageing. Some of us might find ourselves becoming increasingly weak, losing too much weight, walking more slowly or feeling exhausted

6.

These are the key symptoms of frailty. By making healthy choices and keeping our bodies strong, we can prevent or, at least delay, becoming frail as we get older.

Our mental health is just as important as our physical health; the two are connected. We explore this in the next chapter.

What is Derbyshire County Council doing?

This service provides free support to help local people improve their health and wellbeing, including stop smoking, getting more active, losing weight, improving mental health, etc. Since April 2018 the service has helped over 1,200 people to stop smoking and over 750 people to lose weight.

Over the next 12 months the service aims to :

Provide weight management support to families

Help people who are inactive to start exercising

Make the services more accessible to Derbyshire’s most vulnerable people.

Work more closely with partner organisations to support healthier choices

This is a community exercise programme for people aged over 65 years who have fallen or are at risk of falling. It improves strength, balance and coordination. A range of session available across the county, including chair based exercises and Tai Chi.

Over the next 12 months the service will:

Increase the number of sessions in parts of Derbyshire where people might benefit the most.

Link up with other physical activity programmes across Derbyshire such as the walking for health scheme, which provides guided walks around the county. Basic stability exercises will be delivered as part of the walk.

Advise

people about how they can improve

their health by making lifestyle

changes

Act

by offering help and support -

for example, by referring them to Live Life Better Derbyshire or to

Strictly No Falling

Want to find out more?

Live Life

Better

Derbyshire

Heart of

Derbyshire

Active

Derbyshire

Ask

people about their lifestyle - smoking & drinking habits, diet & exercise,

social life & activities

What can health and social

care professionals do?

Strictly No

Falling

Click on the links:

4

Signs of poor mental

health

Signs of good mental

health

Mental health and wellbeing

What is it?

When we talk about someone’s mental health and wellbeing, we mean the way they are thinking and feeling, and how this affects their daily life.

If you have good mental health, you tend to be able to cope with everyday stresses; you are able to feel a range of emotions, build good relationships, feel engaged with the world around you, and deal with the ups and downs of life reasonably well.

But, unfortunately, there are times when life is just not like this. And, when someone’s mental health is not good, even the simplest of tasks can be really tough.

Certain things may make us more vulnerable to experiencing poor mental health. This could include something that happened in the past or might still be happening now, such as:

Childhood experiences

Loss or bereavement

A long term condition

Abuse or violence

Social isolation

Caring for a family member of friend

Poverty or debt

Unemployment14

Our Mental Health Matters

It’s more common than you might think...

Some mental health conditions affect us in small ways; others can have a much greater impact on the way we live our lives.

Did you know that most mental ill health is related to a life situation, an event or a particular period in your life… and is temporary?

Whatever difficulties you are facing, it’s important that you talk with someone you trust. Think about your feelings, try to identify the root cause and seek professional help at the right time if you feel you need it.

Support is out there - whether informal, through friends and family, or from professionals.

Don’t put it off; if you feel you need help, speak up.

Every day

tasks

become

challenging

Can’t

maintain

healthy

relationships

Can’t cope

with change

and

adversity

Every day

tasks are

manageable

Maintain

healthy

relationships

Can cope

with change

and

adversity

1 in 4 of us will have a

period of mental ill health at

some point in our lifetime15

1 in 8 of us aged 5 to 19 had

at least one period of mental

ill health in 201716

9 in 10 mental health service

users experience stigma and

discrimination according to

a 2008 survey17

5

1 in 4 1 in 8 9 in 10

5

What’s happening in Derbyshire?

Across Derbyshire we are doing lots to help people manage their mental health. Here are a couple of examples:

Connect To is a Chesterfield-based service helping local people increase their social connections and access emotional and practical support.

Men Talk provides support for men to help them feel more able to do just this. The service provides a safe space where men can just turn up and share their stories if they want to. Some speak, others listen. It’s a supportive space that can make a difference.

Mental health and wellbeing

Give

Do a kind act

or volunteer

Connect

Build

relationships

with others

Be mindful

Take notice of

you and your

surroundings

Learn

Rediscover an

old interest or

learn a new

skill

Be Active

Go for a walk or

play a sport

5 Ways to

Wellbeing

Try the Five Ways to Wellbeing to look after your

own mental health

Talk Starting a

conversation about

mental health can

be a good way to

break down barriers.

Tips for looking after

each other:

Check You may

spot a change in

your own or

someone else’s

behaviour, a shift in mood or

appearance. Ask if they are ok.

Respect Treat

others with care

and respect.

Creating an

understanding and

non-judgemental environment

makes it easier for people to

talk about their mental health.

Mental health and

frailty - what’s the

link?

Just as our bodies change as we age, so does our brain. In some people changes can occur that are over and above those that are part of normal ageing

18. These can lead to

problems remembering things, feeling depressed or anxious, having difficulty thinking clearly and experiencing low levels of confidence

19.

Although it is possible to be physically frail without being mentally frail and vice versa, there is a connection between the two, and each can make the other worse

18.

Are you a health professional?

Consider signing up to Mental Health Training delivered by Derbyshire County Council Find out more

Interested in finding out more about managing your mental health?

Click on the following links to find out more.

5 ways to

wellbeing

Your Mind

Plan

6

Help you find

opportunities

to learn new

skills and

recognise your

own strengths

Encourage you to develop

good habits, like

choosing healthier

food or taking an

evening stroll

Help you increase your knowledge through sharing experiences

Point you in the right

direction for help when

you need it

Improve the way

you manage

existing health

conditions

Having good social

connections can:

Get together

Try to connect with someone regularly. Even a quick chat on the phone can make a difference.

Volunteer Those who help others in this way say their physical health, self-esteem and confidence improve as a result

21.

Join a club or forum Joining a club or forum is a great way to connect with other people who have shared interests. Are you aged 50+ and would like to influence decisions in your community whilst meeting other people? Why not join the Derbyshire 50+ Forum.

Why does this matter?

In many ways, our social strength can be as important as our physical or mental wellbeing.

According to research20

, people who have good social connections have been shown to be happier and healthier.

They feel they have more control over their lives and are better able to handle the everyday challenges that come their way.

Are relationships important?

Our relationships with the people we know, and our links to where we live, are important because they can have a big impact on our health and wellbeing.

Sometimes called ‘social connectedness’, the networks we are part of, the spaces we share, our sense of belonging and the support we receive (whether emotional, practical or through information) can all help to keep us well.

Strong

relationships

and frailty - what’s the

link?

Connecting with others provides opportunities for physical activity and mental stimulation, both of which can have an impact on frailty.

It’s also a source of support, both emotional and practical. So, good relationships can help us to manage our own health and wellbeing, now and later.

Even though most people agree that connecting with other people can make us feel better, actually doing something about it is not always easy. However, here are three things you can do now, to help change this.

Finding ways to be with others...

Strength in our relationships

7

Want to find out

more?

Click on the links below:

People who work in health and social care can:

Create opportunities for people to make the most of local assets - get to know and let people know about existing programmes that give people a chance to socialise, provide and receive social support, and grow their sense of belonging.

Connecting parents The council has secured funding for a new interactive website to help parents access local groups and arrange to get together. Helping to beat loneliness, manage post-natal depression and build stronger communities.

Locality Social Connectedness Programme We have programmes running in eight areas around the county aimed at building and celebrating social connections in local areas.

Time Swap This scheme connects people with each other based on what they are good at or what they enjoy doing. People earn ‘time’ by supporting a community member, and then ‘cash it in’ to get help from other members.

Social prescribing A personalised prescription that helps people focus on what matters to them and connects them to community groups and services for practical and emotional support in their area.

Four Ways Derbyshire County Council are strengthening our communities 4

1

2

3

4

Think about who might benefit - Older people, young adults and people with poor mental health or disabilities may need opportunities to increase their levels of social connectedness. Others may need extra support at certain times of life such as retirement, when they lose a loved one or when children leave home.

What can health and social care professionals do?

5 ways to

wellbeing

Time

swap

8

50+

Forum

Bring a relative or

friend to an

appointment if

you feel it will

help; there

are also lots

of support

groups out there.

It’s okay to say if you

are not sure about the

information you

have been

given.

Ask if you

want

something

explained.

Before you go to an

appointment,

think about

what

questions you

have. If the

answers don’t

crop up, you can ask.

Don’t be afraid to

talk about your

health issues.

And, if you

are unhappy

with the care

you receive, say so.

4 steps to a better

medical appointment

When information is not explained clearly it can be confusing. For example it may not be clear:

what a test result means

how and when to take medication

how important getting vaccinated is

Making sense of health information is an important part of keeping us healthy. You have to know what things mean, in order to:

Understand the choices you have

find your way around the health care system

Make the best choices about your health

Understanding health information, and making decisions as a result, is referred to by the health profession as health literacy.

Understandable

Is this making

sense?

Informed decision

Yes! I know exactly

what to do

+ =

Understanding

health

information

lets you make

informed

choices

Easy to read

Now this looks good

to read

6/10 have difficulty understanding health information

that includes both words and numbers

Speak

up

Be

honest

Get

support

Prepare

? ? ? ? ?

?

Have you ever struggled to understand something about your health?

Maybe a doctor explained an illness to you in a way that did not make any sense?

Perhaps you’ve found it difficult to keep track of your tablets or understand what a food label is telling you? If so, you are not alone.

Recent research21

tells us that 4 in every 10 people of working age in England have difficulty understanding, and using everyday health information.

It’s not just wording; add numbers into the mix, and even more people are confused.

Working together

9

2. Demonstrate

Demonstrate instructions, such

as portion size or measuring

medication

What’s happening in

Derbyshire?

Our aim is to make everyone think more about health literacy and what they can do to help people understand the information they receive.

As a first step, staff working for Derbyshire County Council’s Stop Smoking Service are going to be looking more closely at the language they use in their work.

Staff will also learn different ways to check in with the people they are helping to quit smoking, to make sure that everything is clear.

This is just the start…

If successful, this work will be expanded to other areas of health and social care throughout Derbyshire.

Tackling health literacy in this way has the chance to really make a big difference.

Better manage our own health and wellbeing needs, as well as those of our families.

By improving our

health literacy we

can:

Health professions: empower those you work with

Make sure we recover as quickly as possible by understanding medical advice.

Find it easier to access the services we need.

Feel more confident when chatting to health professionals.

Make better decisions to help prevent or delay frailty.

Are you a doctor, a health visitor or someone who works in a care home? People with health and social care jobs can sometimes use words and phrases that have very little meaning outside their area of work.

This can be really confusing for anyone without that specialist knowledge. It doesn’t have to be this way; by making small changes, we can tackle this together.

3. Check understanding

Encourage service users to ask

questions; listen well, and

check their understanding

1. Explain clearly

Keep language as simple as

possible

Health literacy

and frailty -

what’s the link?

Health literacy can affect every health choice we make.

If we make good health choices throughout our lives, this will help us to build our health reserves.

Having larger physical and mental health reserves means we may be able to prevent or delay frailty later in life.

Smoking

cessation

Stop smoking

What to ask

your doctor

NHS tips

Professionals: Plain English

Guide

Want to find out more?

Click on the links below:

10

Upgrade the health

potential of your

environment...

The Derbyshire Welfare Rights Team can help you to find out about any benefits you may be entitled to and how to claim. This could help with your living costs.

Click here to find out more

First Contact

Welfare Rights

A healthy environment for all

Good air

quality

Quality

homes

Access

to health

services

Access to

amenities Access

to nature

Crime

free

Healthy

environment

Elements that make a healthy environment

First Contact is a free service for adults living in Derbyshire. It provides an easy way for you to get in touch with local services who can support your wellbeing and help you stay independent.

Some areas First Contact can offer advice to improve your home environment include:

Housing need (is your home fit for purpose?)

Keeping your home warm

Repairs to your home

Home safety and security

Falls prevention

Community transport

Click here to find out more

What does a healthy environment look like?

A healthy environment doesn’t simply mean the countryside; it’s about having places you can get to and enjoy. Good services can be part of this; being able to reach shops, a doctor or optician, plus having transport links so that you can get to other places, can all help to support a person’s wellbeing.

But where we live can sometimes affect our health in a negative way too.

Areas with high levels of air pollution, like smoke and car fumes, can increase the risk of lung disease. If you don’t feel safe going out this could mean you are cut off and isolated which can affect your mental health. You may live in a house with a bad damp problem or without heating in winter which could lead to chest problems and lower your resistance to other health problems.

When it comes to your health, where you live matters.

It is common sense that the quality of our health – and generally how we feel in ourselves (our wellbeing) – can be affected by where we live. The quality of our homes and spaces and places around us can help bring about good health; but they can also have the opposite effect.

Healthy environments are important. This is why this part of the report looks at the homes, communities and the areas where we live, work or study and the effect that these can have on the quality of our health, now and in later life.

11

A healthy

environment and

frailty - what’s the link?

A good environment for health

can help protect us from illness

and makes it easier to make

healthier choices - building up

our health reserves.

For example, good

neighbourhood design can

affect how much we exercise,

how our social lives develop

and our mental health. It can

also help people to live as

independently as possible.

Want to find out more?

Click on the links below:

First

Contact

Welfare

Rights

Derbyshire has one of the best environments

for health in the East Midlands

High Peak

Derbyshire Dales

South Derbyshire

Amber Valley

Erewash

NE Derbyshire

Bolsover

Chesterfield

What is Derbyshire County

Council doing?

Working together

DCC is working with planners

to make sure that health is

thought about when designing

the ‘built environment’ like

homes, property developments

and estates.

The National Planning Policy

Framework (2019)25

recognises

that planners need to create

safe and healthy places for

people to live, with access to

the kinds of facilities and

opportunities that help to build

a sense of community.

Support

Supporting our vulnerable

populations to live in well-

planned and healthy homes has

been marked out as a key priority

as part of the council’s current

Health and Wellbeing Strategy23

.

This is supported by the

Strategic Statement for Planning

and Health across Derbyshire

and Derby City (2016)24

that

outlines key principles for work in

Derbyshire.

Healthier environment

According to research conducted by the University of Liverpool, Derbyshire has one of the best environments for health in the East Midlands

1.

These findings were based on a number of factors, including; access to nature, access to health services, the retail environment and air quality.

However, there is still room for improvement, with some parts of Derbyshire fairing better than others.

Rural areas may not be as healthy as we think. This is caused largely by the isolation of these communities from health services

22.

12

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13

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